From the start, health authorities took the epidemic seriously. In 1986 the government launched a National Programme of Control and Prevention of HIV/AIDS, aimed at controlling the epidemic and providing quality care for HIV-positive people. As a result, Cuba reports an extremely low incidence of HIV in its blood supply and low vertical transmission rates.

Initially, they  interned PHAs, regardless of whether they had symptoms or not, in sanatoriums to prevent HIV infection from spreading further. The sanatoriums provided good medical and psychological support, however, in 1993 a new programme called Ambulatory Care was introduced, mitigating the mandatory character of the original system and focusing on PHAs. They may choose to live in or outside a sanatorium, except when medical authorities fear they will not be able to behave "responsibly". The sanatorium in Havana has designed an eight-week course for people newly diagnosed with HIV to provide them with skills on how to live positively and protect their own health and that of others. Havana is currently experimenting with the possibility of introducing anonymous testing and counselling.

In Cuba, the law protects PHAs against discrimination; they also receive extra material support. As in many other countries they nevertheless suffer from prejudice among the general population, doubly so if they are gay. A specific source of frustration for Cuban PHAs  is that many of them are aware of the latest treatments, but neither they nor their country can afford them. Economic and political sanctions imposed against Cuba by the USA further hamper access to advanced treatment.

Additional services were made available to PHAs in December 1998 with the creation of a National Centre for the Prevention of STDs/HIV/AIDS, an integral part of the Ministry of Public Health. The centre has programmes and services aimed primarily at prevention, such as an AIDS hotline; a counselling service that includes a pilot project with anonymous testing; the Mobile Project, an outreach project for people at risk; and a special support project run by and for PHAs, funded by foreign NGOs.

The PHA project was launched in March 1999 with a workshop for 30 PHAs from Havana. During the workshop, the PHAs identified a lack of information as one of the problems faced by PHAs living outside the sanatoriums. To meet these needs, a small work group of PHAs, experts by experience, organized workshops around important themes and created a guide called "Living with HIV". The guide discusses; basic clinical information about HIV/AIDS;

• PHAs and their social environment;
• nutrition, diet and hygiene;
• sexuality, and
• some legal aspects.

A survey among family doctors who provide first-line assistance in the ambulatory approach revealed a lack of medical and psychological knowledge. Workshops were organized for them and a guide called "Knowing about HIV" has been distributed throughout the country.

The work group received support from experts from the Centre experts and other sources, but the members themselves did most of the work. Though not originally intended, the group itself became a kind of mutual support group. Their experience inspired them to start a project in 1999 to help existing mutual support groups in Havana and create new ones in the provinces.

Today, 8 out of 18 projected groups are functioning in the provinces. They are supported locally by the Ministry of Public Health, and the work group keeps in contact with them. The work group also regularly produces a small information bulletin for PHAs.

Many PHAs work as volunteers for the Centre and its projects, thus contributing to the quality of the Centre's work. They volunteer because they share the Cuban belief in doing community service, and because of what the Centre offers them. It is a place where PHAs can feel free and accepted (even if they are gay), develop and contribute their skills and exchange experiences, and where they feel empowered to support each other and fight for themselves and against the epidemic. This spirit is also promoted in the sanatoriums, finding expression in groups that work on HIV prevention formed by (ex) residents and staff, and in cultural action groups like one called Magic Mountain. An initiative of such a Group, the Memory Project travels around the country with quilts on World AIDS Day, in memory of people who have died of AIDS. Sharing the sadness of AIDS deaths and finding strength in solidarity, it reaches out to PHAs in the provinces who are more isolated.